Managed Care Contract Reimbursement Analyst

If you have at least 3 years of experience in healthcare billing, claims and payer reimbursement activities, this may be a great fit for you. This position will ensure that all Managed Care Payer Contract reimbursement terms are properly captured and maintained timely and appropriately within both our EMR Platform(s) and an EXCEL database file. This role will serve as a liaison between Executive Leadership, Managed Care, Accounting/Finance, and RCM members regarding payer contract rates as well as proper reimbursement calculations, determination, and tracking. Able to identify reimbursement rate trends and issues and communicate those accordingly to both the contracted payers and internal resources.

Essential Responsibilities:

• Collects and maintains accurate data regarding contract rates from payors. Must be familiar with Availity, NaviNet, One Health, UHC Provider Portal, CMS, and other health plan websites. Will also utilize internal platforms effectively such as Practice Edge, Power BI, SharePoint, HST, and eIVF.
• Will ensure organization platforms (Such as eIVF, HST, Practice Edge) are properly modeled and accurately reflect reimbursement rates by payer source in comparison to the Excel File rate tracking/modeling performed to further ensure proper net revenue calculations at the individual account level.
• Documents and updates EMR and spreadsheets with rates and other impactful payment information, annually or more often as needed.
• Assists in the monitoring of payer contract compliance and analysis of accounts receivable related to reimbursement including proper determination of payer overpayments and underpayments based upon negotiated rates.
• Able to effectively communicate any trends and discrepancies to the payer sources accordingly.
• Work with internal teams to review claims payments & investigate anomalies and errors in payments in a provider relations function.
• Basic understanding of reimbursement and payer guidelines related but not limited to billing, such as POS, MPPR, modifiers, RBRVS for both physicians and ASC’s. Must have a good understanding payer Contract Reimbursement terms and methodologies.
• Additional responsibilities as assigned.

Education and/or Experience:

• Must be a tenacious go-getter, have the desire to learn to navigate barriers at health plans and the ability to work through and understand complex payment methodologies.
• 3-5 years’ experience in healthcare billing, claims, Provider relations, claims review.
• 3-5 years’ experience in payer reimbursement activities such as contract negotiations or underpayment/overpayment analysis and recovery activities, & payer contract modeling within an applicable platform.

What we offer you!

• Outstanding benefits including health, vision and dental packages, including HSA/FSA, Life and Disability Insurance
• We also have a no-cost medical, dental, and vision plan for employees
• 18 days of accrued PTO in addition to 10 paid holidays
• Fertility benefits
• 401(k) Retirement Plan
• Employee Assistance Program
• Continuing Education Reimbursement
• We provide a great, family work environment with internal growth opportunities